Common Mental Disorder and early interruption of exclusive maternal breastfeeding in Quilombola women: a population-based study / Transtorno mental comum e interrupção precoce do aleitamento materno exclusivo em mulheres quilombolas: estudo de base populacional

Abstract Objectives: to investigate the prevalence of exclusive maternal breastfeeding (EMBF) and evaluate whether common mental disorder (CMD) and other predictors promote its early interruption (EI-EMBF4). Methods: a cross-sectional study involving all children <24 months (n=252) residing in 50% (n=34) of the Quilombola communities in Alagoas. The EI-EMBF4 was established when EMBF was ≤4 months. The Self-Reporting Questionnaire was used to identify the occurrence of CMD. Other predictors were obtained through interviews. The measure of association was the prevalence ratio calculated by the Poisson regression, following a hierarchical theoretical model. The prevalence of EMBF for 4 and 6 months, and its median duration (survival analysis) were calculated. Results: the prevalence of EI-EMBF4 and CMD was 57.6% and 42.9%, respectively. The risk factors independently associated with EI-EMBF4 were: living in a mud house, maternal age ≤18 years, low birth weight and the use of a pacifier or baby bottle. There was no association with CMD. The prevalence of EMBF for four and six months was 42.4% and 25.4%, respectively, and the median duration was 106 days. Conclusion: EMBF indicators are below the established recommendations, justifying the implementation of measures that prioritize women subjected to risk factors identified here. CMD is not configured among these.

Resumo Objetivos: investigar a prevalência do aleitamento materno exclusivo (AME) e se o transtorno mental comum (TMC) e outros preditores promovem sua interrupção precoce (IP- AME4). Métodos: estudo transversal envolvendo todas as crianças <24 meses (n=252) residentes em 50% (n=34) das comunidades quilombolas de Alagoas. A IP-AME4 foi definida quando o AME foi ≤ 4 meses. Utilizou-se o Self-Reporting Questionnaire para identificar o TMC. Outros preditores foram obtidos por meio de entrevista. A medida de associação foi a razão de prevalência calculada por regressão de Poisson, seguindo modelo teórico hierárquico. Foram calculadas as prevalências de AME por 4 e 6 meses e sua duração mediana (análise de sobrevivência). Resultados: as prevalências de IP-AME4 e do TMC foram 57,6% e 42,9%, respectivamente. Os fatores de risco independentemente associados à IP-AME4 foram: residir em casa de taipa, idade materna ≤18 anos, baixo peso ao nascer e uso de chupeta ou de mamadeira. Não houve associação com TMC. As prevalências do AME por quatro e por seis meses foram 42,4% e 25,4%, nessa ordem, e a duração mediana foi de 106 dias. Conclusão: os indicadores de AME estão aquém das metas estabelecidas, justificando a implementação de medidas que atuem sobre os fatores de risco aqui identificados, sendo que o TMC não se configura entre esses.

Low- level laser: cost of therapy fornipple trauma / Laser de baixa intensidade: custo da terapia no trauma mamilar

Abstract Objectives: to measure the micro-cost of local laser therapy (LL) and transcutaneous laser therapy application by Irradiation Laser Intravascular of Blood (ILIB) to treat nipple trauma and compare the most effective and efficient alternative treatment. Methods: a cross-sectional analytical and quantitative study with analysis on the micro absorption cost, implemented as a clipping, from a randomized clinical trial that used two types of laser therapy to treat nipple trauma due to breastfeeding. The sample consisted of 101 nipple lesions. Patients were randomized into three groups (Control - CG, Local Laser -LLG and ILIB-ILIBG). Materials used, direct labor (DL) and laser equipment were predictors of costs. The delta calculation (effect size) was the indicator for measuring effectiveness and efficiency. Results: after three sessions, the average final cost was R$ 40.04for CG, R$ 53.55for LLG and R$ 67.29for ILIBG. After three sessions of treatment, ILIBG showed a great reduction in the lesion area, but with a higher cost (p<0.05). Conclusions: ILIBG had a better effect on healing the nipple trauma when compared to CG and LLG, even though it is more expensive, it suggests a positive cost-benefit and the most effective and efficient alternative treatment.

Resumo Objetivos: mensurar o microcusteio da aplicação de Laserterapia Local (LL) e trans-cutânea por Irradiation Laser Intravascular of Blood (ILIB) no tratamento de traumas mamilares e comparar a alternativa de tratamento mais eficaz e eficiente. Métodos: estudo transversal analítico do tipo quantitativo com análise de microcusteio de procedimento por absorção, implementado como recorte, de um ensaio clínico rando-mizado que utilizou duas modalidades de laserterapia para tratamento de traumas mamilares ocasionados pela amamentação. A amostra foi composta de 101 lesões mamilares. As pacientes foram aleatorizadas em três grupos (Controle - GG, Laser Local - GLL e ILIB -GILIB). Foram preditores de custos os materiais consumidos, Mão de obra Direta (MoD) e o equipamentos de laser O cálculo Delta (tamanho do efeito) foi o indicador para a medida da eficácia e eficiência. Resultados: após três sessões, a média do custo final foi de R$ 40,04 para o GC, R$ 53,55 para o GLL e R$ 67,29 para o GILIB. Após três sessões de tratamento, GILIB apresentou maior redução da área da lesão, contudo custo mais elevado (p<0,05). Conclusão: o GILIB teve efeito melhor na cicatrização dos traumas mamilares quando comparado com o GC e GLL, mesmo sendo mais caro sugere um custo benefício positivo e a alternativa de tratamento mais eficaz eficiente.

Evaluation of breastfeeding self-effectiveness and its associated factors in puerperal women assisted at a public health system in Brazil / Avaliação da autoeficácia para amamentação e seus fatores associados em puérperas assistidas no sistema público de saúde no Brasil

Abstract Objectives: evaluate breastfeeding self-efficacy and its associated factors in puerperal women assisted at a public health system in Brazil. Methods: it is a cross-sectional analytical study, with convenience sampling and two instruments: sociodemographic, personal and clinical, and Breastfeeding Self-Efficacy Scale (BSES-SF), applied to puerperal women in a puerperal outpatient clinic at two public maternity hospitals in Goiânia/GO, from September to November 2019. Inclusion criteria: mothers in puerperal period, age above 18 years, children born at term and on exclusive breastfeeding. Exclusion criteria: report depression and premature wean. Results: 128puerperal women were interviewed. The average age was 26.7 (± 5.9) years old. The levels of self-efficacy were high (95.3%) and no puerperal had a low level. The variables with statistical significance were: experience in breastfeeding (p= 0.0312), not having received information on breastfeeding during pregnancy (p=0.0292), did not receive other milk at the maternity (p=0.0380), did not feel pain while breastfeeding (p=0.0242), being able to breastfeed on demand (p=0.0124), presence of breast engorgement (p=0.0207), presenting protruding nipples (p=0.0427). Conclusions: clinical and personal aspects were identified as risk factors for early weaning. This can provide information for the training ofprofessionals and structuring the interventions in health services, with a view in preventing these risks.

Resumo Objetivos: avaliar a autoeficácia da amamentação e seus fatores associados em puérperas atendidas no sistema público de saúde. Métodos: estudo transversal analítico, com amostragem por conveniência e dois instrumentos: sociodemográfico, pessoal e clínico, e Escala de Autoeficácia em Amamentação, aplicada a puérperas em um ambulatório de acompanhamento puerperal de duas maternidades públicas de Goiânia/GO, de setembro a novembro de 2019. Critérios de inclusão: mães no período puerperal, idade acima de 18 anos, filhos nascidos a termo e em aleitamento materno exclusivo. Critérios de exclusão: autorrelato de depressão e desmame prematuro. Resultados: foram entrevistadas 128 puérperas. A média de idade foi de 26,7 (± 5,9). Os níveis de autoeficácia foram altos (95,3%) e nenhuma puérpera obteve nível baixo. As variáveis com significância estatística foram: experiência em amamentar (p = 0,0312), não ter recebido informações sobre aleitamento materno durante a gravidez (p = 0,0292), não ter recebido outro leite na maternidade (p = 0,0380), não sentindo dor durante a amamentação (p = 0,0242), sendo amamentada sob demanda (p = 0,0124), presença de ingurgitamento mamário (p = 0,0207), apresentando mamilos salientes (p = 0,0427). Conclusões: foram identificados aspectos clínicos e pessoais como fatores de risco para o desmame precoce. Isso pode fornecer informações para a formação de profissionais e a estruturação de intervenções nos serviços de saúde, visando a prevenção desses riscos.

Factores clínicos y sociodemográficos en lactantes con destete precoz / Clinical and socio-demographic factors in newborns with early weaning

Introducción: El abandono progresivo de la lactancia materna es una nueva situación de salud en la que influyen diversos aspectos. Objetivo: Caracterizar factores clínicos y sociodemográficos referentes al destete precoz en lactantes y su relación con aspectos sociodemográficos de sus madres. Métodos: Estudio observacional, correlacional, de corte transversal, realizado en el Hospital Pediátrico Docente de San Miguel del Padrón. Se conformó una muestra con 520 infantes con edades entre 29 días y 6 meses, destetados precozmente e ingresados en el 2014. La información se tomó de las historias clínicas y de un cuestionario aplicado a las madres. Resultados: Entre 3 y 5 meses de edad se encontraron 56,5 por ciento de los lactantes con predominio masculino (59,0 por ciento) y solo 51,3 por ciento de los casos presentó adecuado estado nutricional. Prevaleció la lactancia mixta (52,9 por ciento). El destete prevaleció entre 4 y 5 meses de edad (53,7 por ciento) y por causas comerciales (43,1 por ciento). Las madres entre 20-34 años fueron las que más destetaron (65,7 por ciento), trabajadoras (53,4 por ciento), de escolaridad media (51,6 por ciento) y en unión consensual (50,6 por ciento). Conclusiones: Los factores clínicos como tipo de destete y valoración nutricional se relacionan con factores sociodemográficos como la edad cronológica del niño y la edad del destete. La edad materna no tiene que ver con el destete precoz ni con sus causas. El abandono precoz de la lactancia materna exclusiva es común e independiente de la ocupación laboral y nivel de escolaridad materna, lo que favorece la malnutrición en los infantes(AU)

ntroduction: The progressive dropping of maternal breastfeeding is a new health situation in which different factors have influences. Objective: To characterize the clinical and socio-demographic factors related to early weaning in newborns and their relation with socio-demographic aspects of their mothers. Methods: Observational, correlational, cross-sectional study in the Pediatric Teaching Hospital of San Miguel del Padrón. It was formed a sample of 520 newborns in ages from 29 days and six months old, whom were early weaned and admitted in the hospital in 2014. The correlation of information was made through the clinical records and a questionnaire applied to the mothers. Results: 56.5 percent of the newborns were between 3 and 5 months old predominating the male sex (59.0 percent), and just 51.3 percent of the cases presented an adequate nutritional state. There was a predominance of mixed lactation (52.9 percent), and the weaning prevailed in the 4 to 5 month of life (53.7 percent), and it was due to commercial causes in the 43.1 percent. Mothers in the ages from 20 to 34 years (65.7percent), mothers who work (53.4 percent), mothers of medium education level (51.6 percent) and in consensual union (50.6 percent) were the ones that practiced weaning the most. Conclusions: There clinical factors as the type of weaning and the nutritional value that were associated with socio-demographic factors as the chronological age of the child and the age of weaning. The maternal ages were not related with early weaning or its causes. Regardless of the job or the educational level of the mother is common the early dropping of exclusive breastfeeding, which favours malnutrition in the newborns(AU)

Longer duration of exclusive breastfeeding reduces maternal weight retention: results from the CLaB study / Maior duração do aleitamento materno exclusivo reduz retenção de peso materno: resultados do estudo CLaB

Abstract Objectives: to evaluate the relation between breastfeeding and postpartum weight reten-tion. Methods: this prospective cohort study involved 641 newborns and their mothers, followed up to twelve months postpartum. Data were collected from June 2015 to February 2017. In the first interview, we investigated data regarding socioeconomic and demographic characteristics, obstetric history, weight, and gestational age of the infant at birth. Maternal weight and breastfeeding status were obtained at 3, 6, 9 and 12 months postpartum at the mother's home. A descriptive analysis of maternal weight retention according to the lactation status was performed. Multiple linear regression models evaluated the effect on exclusive breastfeeding and total breastfeeding duration on maternal weight retention at 6 and 12 months postpartum, considering potential confounders. Results: 512 and 490 mothers were evaluated at six months and at twelve months post-partum, and the mean weight retention was 1.79 (SD=5.52) and 1.69 (SD=6.69) kg, respectively. Regardless of the confounders, the mean postpartum weight reduction for each day of exclusive breastfeeding was 11 (CI95%= -0.019 to -0.003) and 16 grams (CI95%= -0.026 to -0.007) for 6 and 12 months, respectively. The total maternal breastfeeding duration had the same effect. Conclusions: longer periods of exclusive breastfeeding and total breastfeeding are associated with lower postpartum weight retention.

Resumo Objetivos: avaliar a relação entre aleitamento materno e retenção de peso pós-parto. Métodos. estudo de coorte prospectiva com 641 recém-nascidos/mães acompanhados até doze meses pós-parto. Os dados foram coletados de junho/2015 a fevereiro/2017; na primeira entrevista, investigou-se dados socioeconômicos, demográficos, história obstétrica, peso e idade gestacional do lactente ao nascer. Pesos maternos e situação de aleitamento dos lactentes foram obtidos aos 3, 6, 9 e 12 meses pós-parto, em domicílio. Realizou-se análise descritiva da retenção de peso materno segundo situação de aleitamento nesses períodos. Modelos de regressão linear múltiplos avaliaram o efeito da duração do aleitamento materno exclusivo e aleitamento materno sobre retenção de peso materno aos 6 e 12 meses pós-parto, considerando confundidores. Resultados: seis e doze meses pós-parto foram avaliadas 512 e 490 mães, com retenção ponderal média de 1,79 (DP=5,52) e 1,69 (DP=6,69) quilos, respectivamente. Independentemente de confundidores, cada dia a mais de aleitamento materno exclusivo reduziu, em média, 11 (IC95%= -0,019; -0,003) e 16 (IC95%= -0,026; -0,007) gramas a retenção de peso nos dois períodos. A duração do aleitamento materno total teve efeito semelhante. Conclusões: maior duração do aleitamento materno exclusivo e aleitamento materno associam-se com menor retenção de peso pós-parto.

Validation of a tool to evaluate women's satisfaction with breastfeeding for the Brazilian population / Validação de instrumento para avaliação da satisfação da mulher com a amamentaçãopara a população brasileira

Abstract Objective To perform the construct validity and the internal consistency of the Maternal Breastfeeding Evaluation Scale tool, aiming at its application in the Brazilian population. Methods Cross-sectional study that applied the tool to 287 Brazilian women 30 days after childbirth. Main component analysis with varimax rotation was used for the factor analysis, verifying the number of subscales and the maintenance or extraction of the components. Four hypotheses were tested using the unpaired Student's t-test for construct validation. The reliability analysis was performed using Cronbach's alpha coefficient. Results The exploratory factor analysis identified the need to exclude an item and to reformulate the subscales. The results of the construct validity showed that all hypotheses proposed were confirmed: women who were breastfeeding, those who were exclusively breastfeeding, those who did not have problems related to breastfeeding, and those who intended to breastfeed for at least 12 months achieved significantly higher mean values in the scale. The tool showed adequate internal consistency (Cronbach's alpha = 0.88, 95% CI: 0.86-0.90), as did the pleasure and fulfillment of the maternal role subscales (0.92, 95% CI: 0.91-0.93%); child growth, development, and satisfaction (0.70; 95% CI: 0.65-0.75); and maternal physical, social, and emotional aspects (0.75, 95% CI: 0.70-0.79). Conclusions The validation process of the Brazilian version of the Maternal Breastfeeding Evaluation Scale tool showed that it is valid and reliable tool to be applied to the Brazilian population.

Resumo Objetivo Realizar a validação de constructo e avaliar a consistência interna do instrumento Maternal Breastfeeding Evaluation Scale, visando à sua aplicação na população brasileira. Métodos Estudo transversal com aplicação do instrumento a 287 mulheres brasileiras após 30 dias do nascimento da criança. Para a análise fatorial utilizou-se a análise de componentes principais com rotação varimax, verificando o número de subescalas e a manutenção ou extração dos componentes. Para a validação de constructo quatro hipóteses foram testadas pelo teste T-student não pareado. A análise de confiabilidade foi realizada utilizando o coeficiente de alfa de Cronbach. Resultados A análise fatorial exploratória identificou a necessidade de exclusão de um item e a reformulação das subescalas. Os resultados da validade de constructo mostraram que todas as hipóteses propostas foram confirmadas: as mulheres que estavam amamentando, as que estavam em amamentação exclusiva, as que não apresentavam problemas relacionados à amamentação e aquelas com intenção de amamentar por pelo menos 12 meses apresentaram valores médios significativamente superiores na escala. O instrumento apresentou consistência interna adequada (alfa de Cronbach = 0,88; IC95%: 0,86-0,90), assim como as subescalas prazer e realização do papel materno (0,92; IC95%: 0,91-0,93), crescimento, desenvolvimento e satisfação infantil (0,70; IC95%: 0,65-0,75) e aspectos físico, social e emocional materno (0,75; IC95%: 0,70-0,79). Conclusões O processo de validação do instrumento Maternal Breastfeeding Evaluation Scale/BRASIL constatou que ele é válido e confiável para ser aplicado à população brasileira.

Full term newborns in non-nutritive suction evaluationand their relation on feeding performance / Avaliação da sucção não nutritiva de recém-nascidos a termo e sua relação com o desempenho da mamada

Abstract Objectives: To investigate full term newborns suction pattern in non-nutritive suction and their feeding performance. Methods: An analytical descriptive study was carried out from November 2016 to March 2017, with 50 dyads mothers/newborns through the non-nutritive suction evaluation and a direct observation on the newborn's performance on feeding. The data were distributed through simple and relative frequencies (percentages) when categorical or by mean, maximum, minimum and the standard deviation when is continuous, discrete or ordinal. To evaluate the mean differences, the Student's t test was used with significance level of 5%. Results: There were significant differences among the newborn's mandible movement ("newborn's mouth slightly open" p=0,005), suction ("cheek strain during feeding" p<0,001) and dyad mother and newborn positioning ("breasts supported with fingers on the areola" p=0,041 and baby's neck or trunk turned" p=0,041). Conclusions: Newborns that presented changes in their mandible movement on the Non-Nutritive Suction (NNS) also presented difficulties in feeding. The newborn's knowledge on suction pattern through the NNS has proven to be an important strategy that may help identify possible difficulties during feeding.

Resumo Objetivos: investigar o padrão de sucção de recém-nascidos a termo na sucção não-nutritiva e sua relação com o desempenho destes na mamada. Métodos: estudo descritivo analítico, realizado de novembro de 2016 a março de 2017, com 50 díades mãe/recém-nascido, mediante avaliação da sucção não-nutritiva e observação direta do desempenho do recém-nascido na mamada. Os dados foram descritos por meio de frequências simples e relativas (percentuais) quando categóricas ou média, máximo, mínimo e desvio padrão quando contínuas, discretas ou ordinais. Para avaliar diferenças de média foi utilizado o teste T de Student com nível de significância de 5%. Resultados: houve diferenças significativas entre movimentação da mandíbula do recém-nascido e aspectos da pega ("boca do bebê pouco aberta" p=0,005), sucção ("esforço da bochecha durante a mamada" p<0,001) e posicionamento da díade mãe e recém-nascido ("mamas apoiadas com os dedos na aréola" p=0,041 e bebê com pescoço ou tronco torcidos" p=0,041). Conclusões: recém-nascidos que apresentaram alterações na movimentação da mandíbula na Sucção Não Nutritiva (SNN) tiveram também dificuldade na realização da mamada. O conhecimento do padrão de sucção do recém-nascido, através da avaliação da SNN mostrou-se como estratégia importante que pode auxiliar na identificação de possíveis dificuldades do recém-nascido durante a mamada.

Comportamiento de la lactancia materna exclusiva en madres indígenas / Behaviour of exclusive breastfeeding in indigenous mothers

Introducción: La leche materna ha sido considerada como el alimento ideal a ser administrado de forma exclusiva en lactantes hasta los 6 meses y su consumo se ha asociado a la disminución de la morbilidad y mortalidad infantil. Objetivo: Determinar las fortalezas y debilidades que inciden en la implementación de la lactancia materna exclusiva en madres indígenas. Métodos: Se realizó un estudio descriptivo en 171 madres pertenecientes a la provincia de Chimborazo, a las cuales se les aplicó un cuestionario que permitió obtener información relacionada con sus características generales, así como las fortalezas y debilidades que influyeron en la implementación de la lactancia materna exclusiva. Resultados: Promedio de edad de 27 años; predominaron las pacientes casadas (54,38 por ciento), con nivel educacional primario terminado (46,78 por ciento) y con un único hijo (39,19 por ciento); 54,38 por ciento de las madres aplicó correctamente la lactancia materna exclusiva. La fortaleza que mayor significación presentó fue la relacionada con el mejor crecimiento de los niños (88,17 por ciento) y la debilidad más referida fue la falta de descanso de la madre (24,36 percent). Conclusiones: Existen bajos niveles del uso de la lactancia materna exclusiva motivados por debilidades como la falta de descanso de la madre, el dolor en los pezones al lactar y la falta de información sobre lactancia materna exclusiva. Las fortalezas para su uso incluyen fundamentalmente el mejor crecimiento y desarrollo del niño y la prevención de enfermedades y desnutrición(AU)

Introduction: Breast milk has been regarded as the ideal food to be administered exclusively in infants up to 6 months and its consumption has been associated with the reduction of children morbidity and mortality. Objective: To determine the strengths and weaknesses that affect the implementation of exclusive breastfeeding in indigenous mothers. Methods: A descriptive study was carried out in 171 mothers belonging to the province of Chimborazo, whom underwent a questionnaire that allowed collecting information related to their general characteristics, as well as the strengths and weaknesses that influenced the implementation of exclusive breastfeeding. Results: The average age of the mothers was 27 years; married patients predominated (54.38 percent), with primary education level completed (46.78 percent) and with one child (39.19 percent); 54.38 percent of the mothers correctly applied exclusive breastfeeding. The strength of greater significance presented was that related to the best growth of children (88.17 percent) and the most referred weakness was the lack of rest of the mother (24.36 percent). Conclusions: There are low levels of exclusive breastfeeding motivated by weaknesses such as a lack of rest of the mother, pain in the nipples to breastfeeding and the lack of information on exclusive breastfeeding. The strengths for its use primarily include the best growth and development of children and the prevention of diseases and malnutrition(AU)

Comportamiento de la lactancia materna. Consultorio Médico de Familia No. 16. Policlínico "Manuel Piti Fajardo" / Behavior of the breastfeeding. Family Doctor´s Office Nr. 16. Policlínic "Manuel Piti Fajardo"

RESUMEN Introducción: que un niño reciba y se alimente con lactancia materna en las sociedades actuales, cada día es una tarea más compleja. Objetivo: caracterizar el comportamiento de la lactancia materna en el Consultorio Médico de Familia No 16. Policlínico "Manuel Piti Fajardo", municipio Cárdenas. Materiales y métodos: se realizó un estudio observacional, descriptivo, transversal. El universo lo constituyeron 68 madres de nacidos vivos pertenecientes a esa área de salud, en el período de enero 2011 -diciembre 2015. Las variables estudiadas fueron: edad, nivel escolar, ocupación, tiempo de lactancia, factores que incidieron en la suspensión de la lactancia materna, planificación familiar, conocimientos sobre lactancia materna. Los datos se obtuvieron de las historias clínicas familiares e individuales, del registro de nacimientos del Departamento de Estadística del Policlínico, del Análisis Integral de la Situación de Salud del Consultorio, la encuesta y la observación. Resultados: predominó en las madres de nacidos vivos el grupo de edad de 25 a 29 años, con el 41,7 %. El 77,9 % tenían nivel preuniversitario y el 47,0 % eran trabajadoras. El 47,5 % lactan entre 1-3 meses. Incidió en el abandono de la lactancia materna el no tener suficiente leche con un 44,1 %, el 50,0 % no planificaron el embarazo, y el 58,8 % no poseían los conocimientos adecuados. Conclusiones: un elevado porcentaje de las madres lactan hasta los 3 primeros meses de vida, la causa de abandono más frecuente de lactancia materna fue el no tener suficiente leche. Prevaleceieron los conocimientos no adecuados sobre la lactancia materna.

ABSTRACT Introduction: breastfeeding in current societies is a very complex task. Objective: to characterize breastfeeding in the Family Doctor´s Office Nr. 16 of the Policlinic ¨Manuel Pity Fajardo¨, municipality of Cardenas. Materials and methods: a cross-sectional, descriptive, observational study was carried out. The universe was composed by 68 mothers of born-alive children belonging to that health area in the period January 2011-December 2015. The studied variables were age, scholarship, job, breastfeeding time, factors causing breastfeeding delay, family planning, and knowledge on breastfeeding. Data were gathered from the individual and family records, from the births´ register of the Policlinic Statistics Department, from the Comprehensive Analysis of Health Situation, enquire and observation. Results: the 25-29-years-old age group predominated among mothers of born-alive children (41.7 %). 77.9 % had senior high school scholarship, and 47.0 % were workers. 47.5 % of them breastfeed 1-3 months. Not having enough breast milk (44.1 %), a non-planed pregnancy (50.0 %), and not having the adequate knowledge (58.8 %) influenced in breastfeeding delay. Conclusions: a high percent of mothers breastfeed just during the first three months of life; the most common cause of breastfeeding delay was not having enough breast milk. There it was a prevalence of non-adequate knowledge on maternal breastfeeding.

Maternal age influence in human colostrum acidity composition in a Maternity in an country side city of São Paulo State / Impacto da idade materna na acidez do colostro de nutrizes em maternidade do interior do Estado de São Paulo

INTRODUCTION: OBJECTIVE: To analyze sociodemographic and gestational characteristics and to compare colostrum acidity content in adolescent and advanced maternal age mothers METHODS: This cross-sectional study included 98 adolescents (up to 18 year-old) and 33 advanced maternal age (more than 35 year-old) mothers admitted at the maternity of Presidente Prudente Regional Hospital, Brazil. An approximated volume of 10 mL of colostrum was obtained by manual expression of the breasts within 72h postpartum and stored at -20ºC up to processing. Acidity of colostrum was evaluated in Dornic degrees. Statistical analysis was performed using Mann-Whitney test or X² RESULTS: The median age adolescents and advanced maternal age mothers were 20 years (12-24) 37 years (35-45), respectively. The majority of the adolescents (66.3%) were primiparous and C-section delivery had occurred in 66.7% of advanced age mothers. Gestational body mass index (BMI) was statically higher in advanced maternal age women (32.17±5.6 vs 26.09±3.6, p< 0.0001). Acidity measurement was similar between the studied groups CONCLUSIONS: Sociodemographic and gestational characteristics of adolescents and advanced age mothers showed population heterogeneity, thus, specific follow up and orientations should be applied at each one. Colostrum constitution was constant regarding casein and proteins content, independently of maternal age

INTRODUÇÃO: OBJETIVO: Analisar as características sociodemográficas e gestacionais e comparar a acidez do colostro de nutrizes adolescentes e idade materna avançada MÉTODO: Estudo prospectivo transversal, que incluiu 98 nutrizes adolescentes (até 18 anos) e 33 nutrizes com idade materna avançada (maior que 35) atendidas na Maternidade do Hospital Regional de Presidente Prudente. Amostras de aproximadamente 10 mL de colostro foram obtidas por meio da ordenha manual entre 48 a 72h após o parto, e armazenadas a -20ºC até o processamento. A acidez foi verificada por meio da titulação e calculada em graus Dornic. A análise estatística foi realizada utilizando-se o teste de Mann-Whitney ou X² RESULTADOS: A mediana da idade materna das nutrizes adolescentes foi de 20 (12-24) anos, e das nutrizes com idade materna avançada foi de 37 (35-45) anos. A maioria das nutrizes adolescentes (66,3%) eram primíparas e a via de parto cesárea ocorreu em 66,7% das nutrizes em idade materna avançada. O índice de massa corpórea (IMC) gestacional foi estatisticamente maior em nutrizes com idade materna avançada (31,3±5,6 vs 26,06±3,6, p< 0,0001). A acidez do colostro das nutrizes nos extremos da idade reprodutiva não apresentou diferença significativa entre os grupos de nutrizes CONCLUSÃO: As características sociodemográficas e gestacionais de adolescentes e mães com idade materna avançada evidenciam heterogeneidade dessas populações e consequentemente, atendimento e condutas específicas devem ser aplicados a cada uma. A constituição do colostro em caiseina e proteinas apresentou-se constante, independente da idade materna

Exceso de peso y obesidad central y su relación con la duración de la lactancia materna exclusiva / Relation of excess weight and central obesity with the duration of exclusive maternal breastfeeding

Introducción: El abandono precoz de la lactancia materna exclusiva se asocia con el desarrollo prematuro de exceso de peso y adiposidad. Objetivo: Determinar la posible relación entre el exceso de peso y la obesidad central con la duración de la lactancia materna exclusiva. Métodos: Estudio descriptivo que incluyó 162 adolescentes, entre 10-18 años, atendidos en el Policlínico Universitario Carlos Manuel Portuondo, durante el 2016. De las historias clínicas se tomaron los datos de las siguientes variables: edad, sexo, duración de la lactancia materna exclusiva, estado nutricional, grado de obesidad y adiposidad. Resultados: La malnutrición por exceso y por defecto fueron significativamente mayor en pacientes con cinco o menos meses de lactancia materna exclusiva (51,84 por ciento vs 9,26 por ciento respectivamente). El grado de obesidad y la adiposidad se relacionaron con el tiempo de duración de la lactancia materna exclusiva (p= 0,0131 y p= 0,0010 respectivamente). Del total de pacientes con adiposidad, el 81,39 por ciento presentó abandono de la lactancia materna exclusiva antes de los cinco meses de edad. Conclusiones: La lactancia materna exclusiva protege al niño (adolescente) frente al exceso de peso y la adiposidad a corto y mediano plazo(AU)

Introduction: Early dropping out of exclusive maternal breastfeeding it is associated with the premature development of excess weight and adiposity. Objective: To determine the possible relation among excess weight and central obesity with the duration of exclusive maternal breastfeeding. Methods: Descriptive study that included 162 adolescents from 10 to 18 years who were attended in Carlos Manuel Portuondo University Policlinic during 2016. From clinic records were taken the data of the following variables: age, sex, duration of exclusive maternal breastfeeding, nutritional state, stage of obesity and adiposity. Results: Malnutrition by lack or excess was significantly higher in patients with 5 or less months of exclusive maternal breastfeeding (51.84 percent vs. 9.26 percent respectively). Stages of obesity and adiposity were related with the duration of exclusive maternal breastfeeding (p= 0.0131 and p= 0.0010 respectively). Of the total of patients with adiposity, 81.39 percent presented dropping out of exclusive maternal breastfeeding before the five months of life. Conclusions: Exclusive maternal breastfeeding with a proper duration protects children (and then adolescents) of excess weight and adiposity(AU)

Influencia de la lactancia materna en los diastemas fisiológicos de crecimiento / Influence of maternal breastfeeding in the physiologic diastema of growth

RESUMEN Introducción: el amamantamiento ha sido la primera forma de alimentación del género humano. Es indiscutible la repercusión de este acto en el desarrollo integral del niño, y el aparato estomatognático no está ajeno a este influjo. Objetivo: identificar el período de lactancia materna y su repercusión en la presencia de los diastemas fisiológicos de crecimiento. Materiales y métodos: se realizó un estudio descriptivo y transversal, se examinaron los 156 niños, de 2 a 5 años de edad, pertenecientes al círculo infantil "Días de Infancia", del área de salud Playa, en el período febrero 2007-febrero 2008. Los datos obtenidos del examen clínico se reflejaron en un formulario confeccionado al efecto. Variables: período de lactancia materna, espacios fisiológicos de crecimiento, espacios de primate. Los datos fueron procesados en tablas y gráficos. Se emplearon análisis estadísticos. Resultados: el 56,4 % de los niños recibieron lactancia por un período menor de 6 meses. El 15.9 % de los que fueron amamantados por un período menor de 6 meses no presentaban estos espacios. Cuando aumentó el periodo de amamantamiento por más de seis meses, la ausencia de espacios disminuyó y solo se evidenció en el 9.0 % de ellos. El 60.6 % reveló la presencia de todos los espacios. El 1.3 % de los niños no recibieron lactancia materna y, sin embargo, si presentaron todos los diastemas fisiológicos de crecimiento. Conclusiones: se determinó que la mayoría de los niños fueron amamantados por un período de 6 meses o menos. Los diastemas fisiológicos de crecimiento estuvieron más representados cuando la lactancia se prolongó por más de 6 meses (AU).

ABSTRACT Introduction: breastfeeding has been the first feeding form of the humankind. The repercussion of this act is undeniable in the comprehensive development of the child, and the stomatognathic system does not escape to this influence. Objective: to identify the period of maternal breastfeeding and its repercussion on the physiologic diastema of growth. Materials and methods: a cross-sectional, descriptive study was carried out in 156 children aged 2-5 years, assisting the day care center "Dias de Infancia", health area Playa, in the period February 2007-February 2008. Data obtained in the clinical examination were shown in a form elaborated for that. The studied variables were maternal breastfeeding period, physiological spaces of growth, primate spaces. Data were processed in tables and graphics. Statistical analyses were used. Results: 56.4 % of the children were breastfed for less than six months. 15.9 % of those who were breastfed for less than six month did not present these spaces. When the breastfeeding period increased for more than six months, the absence of spaces decreased and was evidenced in only 9.0 % of them. 60.6 % showed the presence of all the spaces. 1.3 % of the children were not breastfed, and nevertheless they did show all the physiological diastemata of growth. Conclusions: it was found that most of the children were breastfed for a period of six months or less. Physiological diastemata of growth were more represented when breastfeeding lasted more than six months (AU).

Influencia del tipo y tiempo de lactancia materna en la aparición de los hábitos deformantes / Influences of the type and time of breastfeeding in the onset of deforming oral habits

Introducción: los hábitos bucales deformantes están estrechamente relacionados con el tiempo de lactancia materna; existen hábitos beneficiosos o funcionales y los incorrectos o deformantes. Objetivo: describir la influencia de tipo y tiempo de la lactancia materna en la aparición de hábitos bucales deformantes en niños de 2 a 4 años. Métodos: se realizó un estudio descriptivo transversal y retrospectivo. El universo estuvo formado por 1021 madres con niños de 2 a 4 años de edad y la muestra integrada por 300 madres con sus respectivos hijos, seleccionados por un muestreo aleatorio simple; se obtuvieron las variables edad, sexo, hábitos bucales deformantes, tiempo de lactancia materna y tipo de lactancia. Resultados: el grupo de 3 años (44,7 por ciento) y el sexo femenino (55,7 por ciento), con uso de chupetes y biberones (45,7 por ciento), como hábito bucal deformante en el sexo femenino; la lactancia mixta (65,3 por ciento) en niños con hábitos, lactancia materna por menos de 3 meses (40,8 por ciento). Predominó el hábito de chupetes y biberones (45,7 por ciento) en todos los tiempos de lactancia, observándose que disminuye a medida que aumenta el tiempo de lactancia materna (4,9 por ciento). Conclusiones: la lactancia mixta y el tiempo de lactancia materna exclusiva menor de 3 meses favorecen la práctica de hábitos bucales deformantes(AU)

Introduction: deforming oral habits are closely related to the time of breastfeeding; there are beneficial or functional habits and the incorrect or deforming ones. Objective: to describe the influence of type and time of breastfeeding in the onset of deforming oral habits in children aged 2-4 years. Methods: across-sectional and retrospective descriptive study was carried out. The universe consisted of 1021 mothers with children aged 2-4 years and the sample was made up by 300 mothers with their respective children, selected by simple random sampling; age, sex, deforming oral habits, breastfeeding time, and breastfeeding type were obtained. Results: the group of 3 years (44.7 percent) and the female sex (55.7 percent), with the use of pacifiers and baby bottles (45.7 percent), as deforming buccal habit in females, mixed lactation (65.3 percent) in children with habits, breastfeeding for less than 3 months (40.8 percent). Predominantly, the habit of pacifiers and baby bottles (45.7 percent) at all breastfeeding time was observed to decrease as breastfeeding time increases (4.9 percent). Conclusions: mixed breastfeeding and exclusive breastfeeding time of less than 3 months favor the practice of deforming oral habits(AU)

Abandono de la lactancia materna exclusiva, causas y consecuencias. Policlínico José L. Dubrocq. Año 2015 / Exclusive breastfeeding discontinuation, causes and consequences. Policlinic José L. Dubrocq. Year 2015

Introducción: la superioridad de la leche materna en la alimentación del recién nacido humano, es incuestionable por ello es un objetivo esencial del Programa Materno Infantil en Cuba. Objetivo: identificar causas y consecuencias del abandono de la lactancia materna exclusiva. Materiales y Métodos: se realizó una investigación descriptiva en el Policlínico de Contreras "José Luis Dubrocq", de Matanzas, de enero 2013 a febrero 2015. La muestra fue de 255 madres con lactantes menores de 6 meses, que cumplieron los criterios de inclusión. Las variables estudiadas: tipo de lactancia, edad de abandono de la lactancia materna exclusiva, causas, consecuencias y valoración nutricional. Para la recogida de la información se aplicó un cuestionario y se revisaron las historias clínicas. Se tuvo en cuenta el consentimiento informado y la voluntariedad. Resultados: la lactancia artificial fue la más utilizada, con un 57,6 %. La edad de dos meses predominó en el abandono de la lactancia materna, para un 38,4 %. La hipogalactia prevaleció como causa para abandonarla (47,1 %). Hubo un 63,2 % de incidencia de enfermedades alérgicas en niños con lactancia artificial, mayor presencia de infecciones respiratorias agudas, con un 87,1 %; enfermedades diarreicas agudas (51,7 %), y malnutridos el 48,3 %. Se encontró el 63,8 % de niños normopeso con lactancia materna exclusiva. Conclusiones: predominó la lactancia artificial a partir de dos meses, con la hipogalactia como causa de abandono de la lactancia materna. De forma proporcional aumentó la aparición de enfermedades alérgicas, infecciones respiratorias agudas, enfermedades diarreicas agudas y niños mal nutridos (AU).

Introduction: it is unquestionable the superiority of breast milk in feeding the new-born human individual. Therefore, it is an essential objective of the Maternal-Infantile Program in Cuba. Objective: to identify causes and effects of the exclusive maternal breastfeeding. Materials and Methods: a descriptive study was carried out in the policlinic "José Luis Dubrocq" of Contreras, from January 2013 to February 2015. The sample was 255 mothers with nursing infants aged less than 6 months, who fulfilled the inclusion criteria. The studied variables were: kind of feeding, age of exclusive breastfeeding discontinuation, causes, consequences and nutritional assessment. For gathering information, a questionnaire was applied and clinical records were reviewed. The informed consent and voluntariness were taken into account. Results: the bottle feeding was the most used one, with 57,6 %. The age of two months predominated in maternal breastfeeding discontinuation, for 38,4 %. Hypogalactia prevailed as a cause for discontinuing it (47,1 %). There it was 63,2 % of allergic diseases incidence in children with bottle feeding, higher presence of acute respiratory infections, with 87,1 %, acute diarrheic infections (51,7 %), and malnutrition (48,3 %). It was found a 63,8 % of norm-weight children with exclusive maternal breastfeeding. Conclusions: bottle feeding predominated beginning form the age of two months, with hypogalactia the cause of discontinuing maternal breastfeeding. In a proportional way, allergic diseases, acute respiratory infections, acute diarrheic infections and malnourished children increased (AU).

Factores que influyeron en el abandono precoz de la lactancia materna en lactantes de un Grupo Básico de Trabajo / Factors influencing in the precocious breastfeeding discontinuation in nursing infants of a Basic Group of Work

Introducción: son múltiples y variados los beneficios que ofrece la lactancia materna, entre ellos, la disminución de la mortalidad y la morbilidad infantil. Si embargo, sigue siendo un grave problema el abandono precoz de la lactancia materna en los lactantes, antes del tiempo recomendado. Objetivo: identificar los factores que influyeron en el abandono precoz de la lactancia materna en lactantes. Materiales y Métodos: se realizó un estudio descriptivo transversal, en un universo conformado por los 120 lactantes que no recibieron lactancia materna exclusiva hasta el sexto mes, pertenecientes al Grupo Básico de Trabajo 1, del Policlínico "José Martí Pérez", en Santiago de Cuba. El periodo comprendido fue desde enero a diciembre del 2014. Para la recolección de los datos se revisaron las historias clínicas de los lactantes y se elaboraron encuestas. Se procedió a la tabulación de los resultados los cuales quedaron recogidos en cuadros estadísticos. Resultados: predominaron e las madres multíparas en edades comprendidas entre 20 y 34 años de edad, para un 62,5 %. Un 27,5 % eran amas de casa, y un 25,8 % técnicos. El 65 % de las madres que participaron en el estudio tenían conocimientos sobre la lactancia materna, pero no recibieron suficiente apoyo de sus familiares. La mayoría de estos niños enfermaron, de ellos un 96,6 % padecieron enfermedades respiratorias agudas. La principal causa del abandono precoz fue la hipogalactia, con un 49,1 %. Conclusiones: se identificaron los factores que influyeron en el abandono precoz de la lactancia materna en lactantes (AU).

Introduction: there are several benefits offered by maternal breastfeeding, among them, the decrease of mortality and morbidity. Nevertheless, the precocious breastfeeding discontinuation - before the recommended time- is still a serious problem. Objective: to identify the factors influencing precocious breastfeeding discontinuation in nursing infants. Materials and Methods: a descriptive, cross-sectional study was carried out in a universe formed by 120 nursing infants who were not under exclusive maternal breastfeeding up to the their sixth month. They belonged to the Basic Group of Work 1, of the Polyclinic "José Martí Pérez", in Santiago de Cuba. The studied period was the one from January to December 2014. The clinical records of the nursing infants and surveys were used for data collection. The results were tabulated and gathered in statistical tables. Results: multiparous women aged 20-40 years predominated for a 62 %. 27.5 % of them were housewives, and 25.8 % were technicians. 65 % of the women who participated in the study had knowledge on the importance of maternal breastfeeding, but they did not have enough support from the part of their relatives. Most of the children got sick, and 96.6 % suffered acute respiratory diseases. The main cause of the precocious breastfeeding discontinuation was hypogalactia, with 49.1 % Conclusions: the factors influencing in the precocious maternal breastfeeding discontinuation were identified (AU).

Razones de abandono de lactancia materna en madres con hijos menores de 2 años / Reasons for breastfeeding abandonment in mothers with children under 2 years of age

La lactancia materna (LM) es la forma de nutrición natural del lactante que se adapta a los requerimientos nutricionales e inmunológicos del niño; suministra los nutrientes de manera completa hasta los 6 meses y de manera complementaria hasta los 2 años. No solo el niño es beneficiado, sino también la madre. A pesar de todos los beneficios que otorga la LM, el Paraguay posee uno de los índices de LM más bajos de la región; es por ello que en este trabajo se buscó establecer las razones por los cuales las madres con hijos menores de 2 años abandonan la práctica de la LM antes del tiempo recomendado a través de un estudio observacional, descriptivo, de corte transversal. La muestra estuvo constituida por 60 madres con hijos menores de dos años que asistieron al Hospital Materno Infantil de Fernando de la Mora en los días que se recolectaron los datos para la encuesta y aceptaron participar del estudio. El 77% de las madres tenía conocimiento sobre la importancia de la LM y sobre la inmunidad que proporciona al niño, sin embargo, solo el 20 % de ellas ponía en práctica la LM de forma exclusiva y un 28% de manera complementaria. Las razones mencionadas por las madres con respecto al abandono de la LM antes del tiempo recomendado fueron en orden decreciente: falta de leche en cantidad suficiente, trabajo de la madre, rechazo del niño, la madre ya no quería dar de mamar.

Breastfeeding (BF) is the infant natural form of nutrition, which adapts to the childnutritional and immunological requirements. It fully supplies the nutrients until sixmonths and complementarily until two years of age. Not only is the child benefited butalso the mother. In spite of all the benefits provided by BF, Paraguay has one of thelowest rates o maternal BF. That is why this study aimed to establish the reasons ofBF abandonment before the recommended time in mothers with children under twoyears of age, who attended the Maternal and Child Hospital of Fernando de la Morathrough a observational descriptive cross-sectional study. The sample was constitutedby 60 mothers with children under two years old who attended the hospital on thedays the data for the survey were collected and who accepted to participate. Seventyseven percent of the mothers had knowledge about the importance of breastfeedingand the immunity provided to the child, however, only 20% of them implemented theBF exclusively and 28% complementarily. Reasons to abandon BF before therecommended time reported by the mothers in decreasing order were: insufficientmilk, work, rejection of the child, no longer wanted to breastfeed.

A prevalência do aleitamento materno exclusivo em crianças de 0 a 6 meses internadas em um hospital pediátrico de Curitiba / The prevalence of exclusive maternal breastfeeding in 0 to 6-month-old inpatient children at a pediatrics hospital in Curitiba / La prevalencia de la lactancia materna exclusiva en niños de 0 a 6 meses internados en un hospital pediátrico de Curitiba

Este estudo tem como tema a amamentação, sendo delimitado no que diz respeito ao impacto do internamento hospitalar de crianças de 0 a 6 meses de idade, no processo de amamentação. O processo metodológico deste estudo se deu por meio de uma pesquisa quantitativa, exploratória, descritiva; as participantes da pesquisa foram mães, de filhos de 0-6 meses, que estavam internados em quatro Unidades de internação em um Hospital Pediátrico da cidade de Curitiba, que estavam amamentando antes do internamento e que aceitaram participar da pesquisa. Na avaliação das mães de 50 crianças que estavam internadas, contatou-se a prevalência de amamentação exclusiva antes do internamento de 32 (60%) crianças; durante o internamento, 16 (32%) crianças permaneciam em aleitamento materno exclusivo. As crianças que passaram a utilizar formula, comparadas às crianças que eram amamentadas exclusivamente foram de 28%, demonstrando um indice elevado de desmame durante o internamento, o que causa grande preocupação, visto os benefícios, que o aleitamento materno exclusivo fornece para as crianças. Obstáculos significativos à prática do aleitamento materno dos lactentes internados podem estar relacionados à falta de rotinas e práticas de incentivo ao aleitamento, além das dificuldades de ordem física, como o desconforto das acomodações para as mães. É de extrema necessidade criar protocolos que incentivem a continuidade do aleitamento materno durante a internação hospitalar, assim como o incentivo ao aleitamento materno reduzindo assim o número de internações.

The subject of the present study is breastfeeding, specifically the impact of hospitalization of 0 to 6-month-old children, in the breastfeeding process. The methodology adopted for this study was a quantitative, exploratory, descriptive research; its participants were mothers of 0 to 6-month-old children who had been admitted into four inpatient care Units of a Pediatrics Hospital in the city of Curitiba. These mothers were breastfeeding prior to their infants' hospital admission and have accepted to participate in the research. Upon assessment of the mothers of 50 inpatient children, the prevalence of exclusive breastfeeding before hospital admission of 32 (60%) children was noted; during hospitalization, 16 (32%) infants remained exclusively breastfed by their mothers. In comparison to those exclusively breastfed, children who started to use formula were 28%, expressing a high rate of weaning during hospitalization, what raises great concern given the benefits exclusive maternal breastfeeding provides to the children. Significant obstacles to the practice of maternal breastfeeding of inpatient nursing children might be related to the lack of breastfeeding routines and incentive practices, in addition to the difficulties of physical nature, such as the uncomfortable accommodations for mothers. The creation of protocols that encourage the continuity of maternal breastfeeding during hospitalization is of the utmost necessity, as well as the encouragement of maternal breastfeeding, thus reducing the number of hospitalizations.

El tema de ese estudio es la lactancia, siendo delimitado a lo que concierne al impacto de la internación hospitalaria de niños de 0 a 6 meses de edad, en el proceso de lactancia. El proceso metodológico de ese estudio se dio por medio de una investigación cuantitativa, exploratoria, descriptiva; las participantes de la investigación fueron madres de hijos de 0 a 6 meses que estaban internados en cuatro Unidades de internación en un Hospital Pediátrico de la ciudad de Curitiba, que estaban amamantando antes de la internación y que aceptaron participar de la investigación. En la evaluación de las madres de 50 niños que estaban internados, se constató la prevalencia de lactancia exclusiva antes de la internación de 32 (60%) niños; durante la internación, 16 (32%) niños permanecieron en lactancia materna exclusiva. Los niños que pasaron a utilizar fórmula, comparados a los niños que eran exclusivamente amamantados, fueron 28%, demostrando un índice elevado de destete durante la internación, lo que genera gran preocupación, dados los beneficios que la lactancia materna exclusiva provee a los niños. Obstáculos significativos a la práctica de la lactancia materna de los lactantes internados pueden estar relacionados a la falta de rutinas y prácticas de incentivo a la lactancia, además de las dificultades de orden física, como la incomodidad de las acomodaciones para las madres. Es de extrema necesidad crear protocolos que incentiven la continuidad de la lactancia materna durante la internación hospitalaria, así como el incentivo a la lactancia materna, reduciendo, así, el número de internaciones.

Características y creencias maternas asociadas al abandono de la lactancia materna exclusiva / Characteristics and maternal beliefs associated to the cessation of exclusive breastfeeding

Objetivo: determinar las características y creencias maternas relacionadas con el abandono de la lactancia materna exclusiva. Métodos: estudio observacional, descriptivo y transversal en 239 madres que culminaron el parto y acudieron al Servicio de Crecimiento y Desarrollo del Niño del Hospital Regional del Departamento de Ica (Perú). Para el análisis bivariado se dicotomizaron las variables de estudio. Se empleó la prueba chi cuadrado cuando las variables fueron categóricas y la prueba t de student para comparar la diferencia de promedios cuando las variables eran numéricas. Resultados: el abandono de la lactancia materna exclusiva se observó en 69 (28,87 por ciento) madres que tenían 23,54 años de edad en promedio (IC 95 por ciento: 22,24-22,84), mientras que aquellas que no abandonaron la lactancia materna exclusiva tenían un promedio de edad de 24,85 años (IC95 por ciento: 23,94-25,76) (p= 0,121). Las creencias inadecuadas: Dar de lactar es doloroso, El biberón es la mejor forma de controlar la alimentación de mi bebé y Dar pecho daña mi imagen corporal, así como la discrepancia de las madres con las afirmaciones La lactancia materna exclusiva es suficiente para satisfacer el hambre de mi bebé y La lactancia materna exclusiva es suficiente para engordar a mi bebé, se asoció con mayor proporción de abandono de la lactancia materna exclusiva (p< 0,05). Conclusión: las creencias maternas inadecuadas sobre la lactancia materna están ligadas al abandono de la lactancia materna exclusiva(AU)

Objectives: to determine the characteristics and maternal beliefs about the cessation of exclusive breastfeeding. Methods: observational, descriptive and cross-sectional study of 239 women who had given birth and had gone to the Service for child growth and development located in the Regional Hospital of Ica department in Peru. The bivariate study required dichotomizing the study variables. The Chi-square test was used for categorical variables whereas the Student´s t test served to compare the differences among averages when variables were numerical. Results: sixty nine mothers (28.87 percent), aged 23.54 years as average (CI 95 percent 22.24-22.84), ceased to breastfeed their children whereas those mothers continue breastfeeding were 24.85 years-old as average (CI 95 percent: 23.94-25.76) (p= 0.121). Incorrect beliefs such as breastfeeding is painful, Breastfeeding is the best way of managing my baby´s feeding and breastfeeding damages my body image as well as the disagreement of mothers with the statements Exclusive breastfeeding is enough to satisfy the baby´s hunger and Exclusive breastfeeding is enough for my baby to gain weight were associated to a higher number of mothers who ceased exclusive breastfeeding (p< 0.05). Conclusions: Incorrect maternal beliefs are related to the cessation of exclusive breastfeeding(AU)

Influencia de la lactancia materna en la prevención de hábitos bucales deformantes / The influence of maternal breast-feeding in preventing deforming buccal habits

Introducción: la lactancia materna constituye uno de los pilares fundamentales de la promoción de salud y la prevención de numerosas enfermedades. Objetivo: identificar la influencia de la lactancia materna exclusiva con la presencia de hábitos bucales deformantes. Métodos: se realizó un estudio observacional descriptivo de corte transversal en niños 3-5 años de ambos sexos, pertenecientes al círculo infantil “20 primaveras”, del municipio de Cienfuegos, en el período comprendido entre septiembre de 2011 y marzo de 2012. El universo estuvo constituido por 193 infantes, y la muestra que se utilizó fue aleatoria estratificada, que incluyó a 107 niños. Para la recolección de información, se utilizó una encuesta confeccionada al efecto, los datos fueron procesados en tablas confeccionadas al efecto y la medida resumen que se utilizó fue el porcentaje. Resultados: predominó el sexo femenino, con 56 hábitos, para un 52,3 %; y el grupo de edad de 4 años, con 39, para un 36,4 %. 69 niños son portadores de hábitos bucales deformantes, para un 64,4 %. En relación al tiempo de lactancia materna y la presencia de hábitos bucales deformantes, el 86,6 % de los que recibieron lactancia materna de 0-3 meses eran portadores de hábitos bucales deformantes. Conclusiones: los hábitos bucales deformantes disminuyeron a medida en que aumentaba el tiempo de lactancia materna. Se concluyó que el total de los niños que realizaron lactancia materna exclusiva, los hábitos bucales encontrados fueron en orden decreciente: uso de biberones y chupones, succión digital y deglución atípica, los cuales parecen estar en estrecha relación con el tiempo de lactancia materna. La alimentación al seno materno, contribuye a evitar la aparición de hábitos bucales deformantes.

Background: maternal breast-feeding is one of the main pillars of the health promotion and prevention of numerous diseases. Aim: identifying the influence of exclusive maternal breast-feeding on the presence of deforming buccal habits. Methods: We carried out a cross-sectional descriptive study in both-genders children aged 3-5 years, assisting the day-care center “20 primaveras”, municipality of Cienfuegos, in the period from September 2011 to March 2012. The universe was formed by 193 children, and the stratified randomized sample included 107 children. To collect data, we used an inquiry made up for that subject; data were processed in charts and the outcomes were given in percents. Outcomes: there it was a predominance of the female gender, with 56 habits, 52,3 %; the age group of children aged 4 years predominated, for 64,4 %. In relation with the time maternal feeding lasted and the presence of buccal deforming habits, 86, 6 % of the children who were breast fed up to 3 months showed deforming buccal habits. Conclusions: deforming buccal habits decreased in direct relation with the time maternal breast feeding lasted. We arrived to the conclusion that in children who had exclusive maternal breast feeding, the deforming buccal habits in decreasing order were: baby bottles and pacifiers’ usage, digital suction and atypical swallowing which seem to be in tight relation with maternal breast feeding lasting. Maternal breast feeding contributes avoiding deforming buccal habits.

Uso de hipoglicemiantes orales durante la lactancia / Use of oral hypoglycemic agents during breastfeeding

Antecedentes: Los hipoglicemiantes orales son una alternativa emergente en el tratamiento de la diabetes mellitus gestacional (DMG), pero existe poca información acerca de su uso durante la lactancia. Objetivo: Revisar la evidencia respecto a la seguridad del uso de los hipoglicemiantes orales durante la lactancia. Resultados: Encontramos 3 trabajos que evaluaron el paso de metformina a la leche materna: hubo traspaso de metformina a leche materna en todos los casos. La concentración de metformina excretada a la leche fue en promedio 48 por ciento de la concentración plasmática materna. Las dosis calculadas que recibieron los lactantes en promedio fue 0,38 por ciento de la dosis materna, ajustada por peso. La concentración promedio de metformina en los lactantes fue de 0,025 mg/L. No se reportaron efectos adversos en los lactantes, incluso en el seguimiento a 6 meses de vida. Se encontró sólo un trabajo en relación a glibenclamida y lactancia materna, en el que no se detectó excreción del fármaco a la leche materna. Conclusiones: Los hipoglicemiantes orales parecen ser medicamentos seguros durante la lactancia, sin embargo, la evidencia es escasa. Sugerimos el uso de la glibenclamida por sobre metformina, por su nulo paso a la leche materna.

Background: Oral hypoglycemic agents are an emergent therapy for the treatment of gestational diabetes mellitus (GDM), but there is little information about its use during breastfeeding. Objectives: To review the available evidence regarding the use and safety of oral hypoglycemic agents during breastfeeding. Results: We found 3 studies that described the transfer of metformin to breast milk; there was transfer of metformin to breast milk in all cases. The concentration of metformin in breast milk was 48 percent of the maternal plasma concentration. The calculated dose for the infants was 0.38 percent of the maternal weight adjusted dose. The mean concentration of metformin in the infant's plasma was 0.025 mg/L. No adverse effects were reported in the infants, including 6 months of follow-up. Only one study investigated glyburide and breastfeeding, showing no excretion to breast milk. Conclusion: Oral hypoglycemic agents seem to be safe during breastfeeding; however, the available data is scarce. We suggest the use of glyburide over metformin because of its null excretion to breast milk.